[P1-108] Pediatric Autoimmune Encephalitis (Anti-N-Methyl-D-Aspartate Receptor Encephalitis Suspected): A Case Report
[Introduction]
Autoimmune encephalitis is a diverse group of neuro-psychiatric disorders; anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is most frequent in the pediatric population. The majority of cases of anti-NMDAR encephalitis are idiopathic, but investigations for previous infection and paraneoplastic origin are needed. Anti-NMDAR encephalitis has a characteristic clinical syndrome in most patients. Patient initially present with a prodrome of neuro-psychiatric symptoms, often with dyskinesias followed by progressively worsening seizures, agitation, and spasticity, which may result in severe neurologic deficits and even death.
[Case Illustration]
A 12-year-old previously healthy boy, presented with behavioral changes and difficulty speaking. There’s no previous infection or tumor reported. Shortly, he developed hallucinations and presented with generalized tonic-clonic seizures. He was admitted to the hospital and suspected to have viral encephalitis. Analysis of cerebrospinal Fluid (CSF) showed no marked change. Brain imaging was normal. His seizures became increasingly difficult to identify as he began to exhibit dyskinetic movements with decreased level of consciousness. He was intubated and transferred to the ICU. An electroencephalography showed general slowing associated with diffuse encephalopathy. There are negative results of paraneoplastic investigation. He was given steroid and intravenous immunoglobulin therapy in the beginning but showed no improvement. Rituximab therapy began with CSF test of Anti-NMDAR antibody was planned. His conditions worsen with urinary infection and pneumonia.
[Conclusion]
Autoimmune encephalitis should be in the differential diagnosis of any type of encephalitis. The diagnosis is based on autoantibodies detections and characteristic clinical profiles. Aggressive immunotherapies are often needed.
Autoimmune encephalitis is a diverse group of neuro-psychiatric disorders; anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is most frequent in the pediatric population. The majority of cases of anti-NMDAR encephalitis are idiopathic, but investigations for previous infection and paraneoplastic origin are needed. Anti-NMDAR encephalitis has a characteristic clinical syndrome in most patients. Patient initially present with a prodrome of neuro-psychiatric symptoms, often with dyskinesias followed by progressively worsening seizures, agitation, and spasticity, which may result in severe neurologic deficits and even death.
[Case Illustration]
A 12-year-old previously healthy boy, presented with behavioral changes and difficulty speaking. There’s no previous infection or tumor reported. Shortly, he developed hallucinations and presented with generalized tonic-clonic seizures. He was admitted to the hospital and suspected to have viral encephalitis. Analysis of cerebrospinal Fluid (CSF) showed no marked change. Brain imaging was normal. His seizures became increasingly difficult to identify as he began to exhibit dyskinetic movements with decreased level of consciousness. He was intubated and transferred to the ICU. An electroencephalography showed general slowing associated with diffuse encephalopathy. There are negative results of paraneoplastic investigation. He was given steroid and intravenous immunoglobulin therapy in the beginning but showed no improvement. Rituximab therapy began with CSF test of Anti-NMDAR antibody was planned. His conditions worsen with urinary infection and pneumonia.
[Conclusion]
Autoimmune encephalitis should be in the differential diagnosis of any type of encephalitis. The diagnosis is based on autoantibodies detections and characteristic clinical profiles. Aggressive immunotherapies are often needed.